At what cost?

Patients in England will be able to access cheaper hormone replacement therapy (HRT) through a new prescription prepayment certificate (HRT PPC), the Department of Health and Social Care (DHSC) announced last month (February 2023).

From 1 April 2023, individuals who usually pay for their HRT prescriptions will be able to purchase an annual HRT PPC for the cost of two single prescription charges. Valid for 12 months, this certificate can be used against any listed HRT prescription items licensed for menopause treatment, including tablets, patches and sprays.

The HRT PPC will be available to purchase through the NHS Business Services Authority website or in person at any pharmacy registered to sell PPCs. Patients with a HRT PPC will continue to pay prescription charges for any other non-HRT medicines.

Prescription disruption

Upon this announcement, the Pharmaceutical Services Negotiating Committee (PSNC), though it remained fully supportive of the Government’s decision to improve costs and accessibility to HRT, expressed concerns. The organisation believed “that the introduction of this new PPC specifically for HRT medicines is complex, and in some circumstances it will not work well with existing prescription processing and pricing systems currently used in England”.

The main issue they focused on is that a prescription cannot be processed as both ‘exempt’ and ‘paid’ within the NHS prescription processing and pricing systems. In November 2022, the PSNC wrote to Ministers highlighting such concerns, suggesting “to make all HRT medicines free-of-charge items as this would make it easier to implement and more cost-effective”.

New regulations

To help support pharmacy teams with the current situation, the DHSC introduced new guidelines this month providing three options regarding mixed prescriptions. These will also take effect on 1 April 2023.

1. Refuse to dispense a mixed prescription issued to the patient and ask them to go back to the GP to obtain two separate prescriptions
2. Either dispense the listed HRT item, for free, or the other non-HRT medicine, with charges. This option may be most appropriate if the patient has an urgent clinical need for one of the medications
3. Dispense both the HRT item and the other medicine and complete an FP57 refund form for the HRT item and charge for the other medicine.